Episode 55: Optimizing Female Hormones with Heather Lucas, MSN, FNP-C

Podcast Drop Date: 4/2/2025

In this episode of The Functional Medicine Foundations Podcast, host Amber Warren, PA-C, sits down with Heather Lucas, MSN, FNP-C, a new provider at FMI Center for Optimal Health, to talk about optimizing female hormones. They dive into the key sex hormones: estrogen, progesterone, and testosterone, plus the impact of cortisol and thyroid on overall hormonal health. Hormonal imbalances impact more than just mood and energy. Listen to the full episode to learn how these imbalances impact the body and discover practical ways to optimize hormones naturally, including insights into hormone replacement therapy.

Transcript:

Amber Warren, PA-C: Welcome to the Functional Medicine Foundations podcast, where we explore root cause medicine, engage in conversation with functional and integrative medicine experts, and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper.

Amber Warren, PA-C: Hi, everybody. Welcome back. We're here with Heather Lucas to talk all things female hormones, which is always a very engaging and exciting conversation. So Heather Lucas is a functional medicine nurse practitioner with a deep passion for hormone optimization, sexual wellness, peptides, metabolic health and longevity. She believes you deserve to feel your best to show up with your for your family, your career, your friends and yourself outside of work. Heather enjoys skiing, camping, and making cherished memories with her family. I love that bio. So to the point. So straightforward and so simple. I love it and so important on what we touch on. Welcome.

Heather Lucas, MSN, FNP-C: Yes. Thank you. Thank you for having me.

Amber Warren, PA-C: You're practicing here now at our Eagle facility, Center for Optimal Health.

Heather Lucas, MSN, FNP-C: Yes

Amber Warren, PA-C: With Functional Medicine of Idaho. And we're so excited to have you. I feel like we've definitely done a handful of topics, I should say podcasts on this topic of hormonal health when it comes to females, but I feel like we haven't really hit hard. What I want to make sure we hit hard tonight, which is optimization, right? Which is really what we're about here at the Center for Optimal Health. So let's just start with talking about, as we age, you know, and you and I talk so much about what's going on with our bodies. Right? As women in our late, late 30s and early 40s. So as we age, what what kind of shift do we start to see with our hormones?

Heather Lucas, MSN, FNP-C: Great question. So many women come into our clinic in their late 30s, early 40s when they start to see these hormonal changes, and maybe they're just a little less tolerant of stress, or they're noticing some mood swings or dry skin or insomnia.

Amber Warren, PA-C: Weight gain.

Heather Lucas, MSN, FNP-C: Weight gain. Yeah. Women have three primary sex hormones progesterone, estrogen and testosterone. And they really start to fluctuate kind of in our mid 30s and oftentimes after the birth of our second child, we'll notice some big hormonal changes that we just can't seem to bounce back the way we did after the birth of our first child. And so we see these decline in, in these hormones that lead all the way up through menopause, which in the United States, the average age of menopause is 51. And we know what happens at that age is when our ovaries just kind of quit.

Amber Warren, PA-C: Kaboom!

Heather Lucas, MSN, FNP-C: Working and producing those feel good hormones for us. So shifts in these hormones can include a variety of symptoms. I've already spoke of a couple of them, but irregular periods, hot flashes, night sweats, anxiety, depression, mood swings, vaginal dryness, increase in headaches, weight gain, especially around the midsection. That seems to be one that changes in our estrogen levels will change our body composition and how we store excess body fat. Changes in our ability to put on lean muscle as our testosterone declines and we're still lifting weights in the gym. We're just struggling to put on lean muscle or even trying to lose those last 5 vanity pounds, or whatever.

Amber Warren, PA-C: That body composition that we women are like. This used to be no big deal, and now it's just that lean body mass and fat loss that women start to really struggle with.

Heather Lucas, MSN, FNP-C: Exactly. And it's so frustrating.

Amber Warren, PA-C: You feel like you're doing everything right, aren't they?

Heather Lucas, MSN, FNP-C: They don't work anymore. Our old tricks to how we used to be able to to shape our bodies. How about decrease in libido?

Amber Warren, PA-C: Yeah.

Heather Lucas, MSN, FNP-C: I mean, a lot of women come in. Vaginal dryness, decreased libido, you know, just no interest in sex. This is a shift in our hormones that cause some of these things. Less energy and insomnia, waking up at 2 to 3 a.m., not able to go back to sleep. The monkey brain. Your mind is spinning. Could be from a decrease in our progesterone our our calming hormone. Post menopausal, after that age 51 or when you have gone more than 12 months, that's the definition of menopause. Or you've gone more than 12 months without a regular monthly cycle. We would see these hormone deficiencies even increase further, which leads to increased risk of cardiovascular disease, osteoporosis,

Amber Warren, PA-C: Alzheimer's, dementia.

Heather Lucas, MSN, FNP-C: Dementia, a lot of it related to low levels of estrogen.

Amber Warren, PA-C: Yeah. I think there's a myth that that we just, like estrogen levels just slowly decline. Kind of like men and testosterone. Right? And then just really drop after menopause. And sometimes that can be the case. But in in more instances we actually see estrogen swinging big in perimenopause. Right? So it isn't actually necessarily the estrogen deficiency. It's the huge swings in estrogen that we see in perimenopause driving a lot of these symptoms. We think of low libido as mostly like being driven by testosterone, but a lot of it's estrogen swings as well.

Heather Lucas, MSN, FNP-C: Absolutely.

Amber Warren, PA-C: That's causing some of the low libido and weight gain and things like that. Wonderful. So we see so talk to us like mention the top. I'm kind of putting you on the spot here, but when we talk about the three hormones, you just said, what are the three things that come to your mind? Or the top 2 or 3 things that come to your mind with each hormone, right. So testosterone, we've got like libido and drive motivation. That's what I think of mostly with testosterone as it starts to decline in women. And it's probably worth mentioning. Testosterone is, we do see it drop similar to men. You know, we have much lower levels than men do, but still a very potent and important hormone in us. And we do see a slow shift of testosterone, right? That's not one that we see kind of.

Heather Lucas, MSN, FNP-C: It's not a fluctuating one, but just a slow decline as we age. Our ovaries just aren't as efficient at creating optimal levels for us anymore.

Amber Warren, PA-C: Right. Yeah. No, that's that's good. And progesterone. Same thing. It's really fluctuating throughout perimenopause. Yeah we see it really dip in what we call the luteal phase.

Heather Lucas, MSN, FNP-C: Yes. The time between ovulation and the start of our, of our period. When you might notice things like, uh, more insomnia or you're kind of snapping at your husband or your kids, or just you sometimes look at yourself in the mirror and be like, I don't even know who I am right now. It just feels so different. How come I can't? I was able to handle this a few years ago, but now I'm not able to handle it the same way.

Amber Warren, PA-C: Yeah, you've actually helped teach me with some of the specialty hormone training. You've done a lot of the really the more uncommon symptoms we see in women, that can still be I shouldn't even call them rare, but just a little more uncommon.

Heather Lucas, MSN, FNP-C: Sure.

Amber Warren, PA-C: Right.

Heather Lucas, MSN, FNP-C: Yeah.

Amber Warren, PA-C: What are some of those? Because I think some women are left, like, without answers to some of these more uncommon symptoms.

Heather Lucas, MSN, FNP-C: Sure. So dry eyes, dry and itchy ears.

Amber Warren, PA-C: That's right.

Heather Lucas, MSN, FNP-C: So those are some kind of things that you might not attribute that to a hormone fluctuation, but drying of our mucous membranes. You know, estrogen is really important in in lubrication of our mucous membranes and our joints. It is..

Amber Warren, PA-C: So joint pain.

Heather Lucas, MSN, FNP-C: Joint pain might be another one like hips and knees. A lot will will bother women when their estrogen is fluctuating.Heart palpitations.

Amber Warren, PA-C: Yeah. That's right.

Heather Lucas, MSN, FNP-C: Kind of like a beating in your chest for no reason. You're just sitting there and feel very anxious with it.

Amber Warren, PA-C: And so if you go to your conventional primary care or general care physician, they might give you an anti-anxiety medication, assuming it's stress and anxiety. But really it's your hormones fluctuating as you get closer to menopause.

Heather Lucas, MSN, FNP-C: Right.

Amber Warren, PA-C: And so just some hormonal support can take away those heart. Because I feel like heart palpitations are one that we actually hear a lot of women complaining of. Sure. And I think oftentimes it is just chalked up to stress and anxiety.

Heather Lucas, MSN, FNP-C: Another one would be frozen shoulder.

Amber Warren, PA-C: Yes.

Heather Lucas, MSN, FNP-C: A lot of menopausal women will experience frozen, frozen shoulder and think that there's an orthopedic issue when really it's just related to a decline in estrogen and that, again, that lubrication in the joints keeping the the the cartilage and the capsule supple, supple and flexible and and able to move freely. We see changes in our, our lipid panels.

Amber Warren, PA-C: Yes.

Heather Lucas, MSN, FNP-C: For our our cholesterol. Eating the same diet. But now all of a sudden we have high cholesterol. What is that going on? What's going on there related to our fluctuating hormones again.

Amber Warren, PA-C: Yeah. And same with blood sugar. Right.

Heather Lucas, MSN, FNP-C: And blood sugar regulation. Exactly.

Amber Warren, PA-C: We actually closely follow. And our chief medical officer, Dr. Holthouse has asked us to to start keeping data on women. Their hemoglobin A-1c, which is an average three months of blood sugar and lipid panels and what, what those look like prior to optimizing women's hormones and then after. And men too. Really? We shouldn't leave the guys out of that, out of this conversation in that regard, for sure. You know, the before and after cardiac panels and blood sugar profiles are pretty impressive when you improve somebody's hormones. I love it. It's so good.

Heather Lucas, MSN, FNP-C: Along with that dry eyes and itchy ears, I was listening to another podcast earlier today that was talking about an increased in dental cavities related to the dry mouth, and that she had been visiting with some dentists in her peer group or whatever. And they were saying that they will see a lot more an increase in like perimenopausal menopausal women coming in with, well, I haven't had cavities for 15 years. And now all of a sudden I'm getting cavities in my mouth from the dry mucous membranes and not producing as much saliva to wash away the bacteria and stuff that are creating those cavities.

Amber Warren, PA-C: It makes so much sense.

Heather Lucas, MSN, FNP-C: Yeah. So kind of some some fringe.

Amber Warren, PA-C: Yeah.

Heather Lucas, MSN, FNP-C: Symptoms, things that you wouldn't really chalk up to You hormone imbalances, but.

Amber Warren, PA-C: Or you might not know is actually happening because you're so focused on the mood changes and the weight gain and the libido issues. Right. Or the brain fog. And then until you work to optimize your hormones and you're like, oh, wow, I didn't you know, it's like one of those things that you might not realize that was not optimal until you get your hormones optimal and you realize, oh, my joints feel so much better, or my mouth and eyes aren't as dry or my skin. Skin is another one to kind of the creepy crawly. More wrinkles. Your skin just looks dry and like it's aging, right? More without that potent antioxidant. Yeah. So good. Anything else?

Heather Lucas, MSN, FNP-C: Chronic UTIs. So many women suffer with they call it what is it? Genitourinary syndrome. Where? yeah. Just painful intercourse. Chronic UTIs leaking when you cough, sneeze or laugh, all of those kinds of things can be related to a decrease in your estrogen, which is it's our hormone of vitality. It's our youthful hormone. What makes our skin plump.

Amber Warren, PA-C: And.

Heather Lucas, MSN, FNP-C: Youthful and anti-aging? Yeah. Helps to prevent wrinkles. All those things.

Amber Warren, PA-C: Mm. So good. Oh, goodness. Everybody. Everybody just needs some hormone help. So yeah. So we can see some of these perimenopausal symptoms happening in our 30s. Because the average age of or I shouldn't say average I don't even know the statistic. Maybe you do. How long does perimenopause actually last?

Heather Lucas, MSN, FNP-C: I think it's very individualized for every every woman out there. So many different things will impact when you start to lose hormones. Environmental toxins, stress, your diet, your gut health, your activity level, your detoxification ability through your liver. All of these things will impact. So yeah, I think most of the literature says like late 30s, early 40s, you start to lose progesterone, also quickly followed by loss of testosterone. And then you get the fluctuations of estrogen until you hit menopause. And then the estrogen stops and and hopefully you're already on hopefully oral progesterone. Yeah.

Amber Warren, PA-C: Yeah. To help you with that that that dip I know it is. It's like we have to have the babies and we have our estradiol levels just tank overnight. And these men just get to have a little just gonna slowly come down. All right man we'll.

Heather Lucas, MSN, FNP-C: We can handle it.

Amber Warren, PA-C: Yes. Yes he did. No. We. Yeah. He never. He decided he wouldn't give us more than we can handle. That's so true. Okay, so there's so many more hormones to talk about, right? We talked about three sex hormones, but there's other hormones that obviously play a huge role in this topic of hormonal balancing as we age. And so DHEA is another sex hormone pro hormone. And then I think we also in that same in that same area of concern, we want to talk about DHEA or sorry I just mentioned DHEA.

Heather Lucas, MSN, FNP-C: Cortisol

Amber Warren, PA-C: Thank you. Cortisol our body's stress hormone. So let's talk about how those two change as we age and are related to perimenopause.

Heather Lucas, MSN, FNP-C: Sure. Well, as women age, they may experience higher levels of cortisol. That's, as you already mentioned, our stress hormone, especially during perimenopause due to the fluctuating estrogen and progesterone that impacts our cortisol. Chronic stress can worsen hormone imbalances and contribute to symptoms like anxiety, insomnia, and weight gain. DHEA is a hormone produced in the adrenal glands. It's a prohormone. It's upstream from estrogen and progesterone production and helps if we have if we have healthy levels of DHEA, where our body is able to better produce estrogen and testosterone on its own as well.

Amber Warren, PA-C: Right.

Heather Lucas, MSN, FNP-C: So its levels generally peak in early adulthood and to gradually decline. With age. So, you know, in our conventional medicine world we would be lucky if a provider would really even check a DHEA level. And in functional medicine we look at DHEA on almost everybody, right?

Amber Warren, PA-C: Because it's an easy blood test.

Heather Lucas, MSN, FNP-C: It's an easy test.

Amber Warren, PA-C: It's no like this specialty $500 test. It's a blood test. You check for a sulfated version of DHEA in the blood.

Heather Lucas, MSN, FNP-C: And it's easily replaceable through oral supplementation. Right. Compounded or over-the-counter versions of DHEA replacement. Mhm. Conventional approach to managing low cortisol might be with corticosteroids, which has its whole host of other side effects that you don't want. And and managing high cortisol they might do with anti-anxiety medications such as Xanax or other pharmaceuticals. And an integrative approach or a functional medicine approach to cortisol would include stress management techniques like meditation, yoga, deep breathing exercises, using nutrition, including adaptogenic herbs such as ashwagandha can help control cortisol. Rhodiola and holy basil are also great adaptogens that help with stress management.

Amber Warren, PA-C: Yeah, I love all three of those.

Heather Lucas, MSN, FNP-C: And, you know, optimizing our sleep. That's our bodies time to rest and repair and detox. So if we're optimizing our sleep, those are other ways to help to manage our cortisol levels. And exercise is always a great way to manage stress.

Amber Warren, PA-C: Oh my goodness.

Heather Lucas, MSN, FNP-C: It releases all kinds of endorphins and feel good hormones that just counteract that stress. Not just counteracting the stress, but being physically active and sweating helps to release some of the stress that we're carrying in our bodies the tight shoulders, the headaches coming from muscle tension, all of those kinds of things. Exercise.

Amber Warren, PA-C: But ladies, please don't go do seven days of hit training.

Heather Lucas, MSN, FNP-C: Yeah.

Amber Warren, PA-C: We don't need seven days of high intensity interval training at our stage.

Heather Lucas, MSN, FNP-C: Just even going for a walk.

Amber Warren, PA-C: Yeah

Heather Lucas, MSN, FNP-C: A walk. A nature walk. Just being out, getting sunlight on your skin and fresh air in your lungs. Deep breathing. So many times I even catch myself walking around throughout the day and realizing I'm just shallow breathing. I'm not even breathing deep into my lungs. If I just take 30 seconds and take 3 to 5 deep breaths filling my lungs. Stress just kind of melts away with that.

Amber Warren, PA-C: It's so true.

Heather Lucas, MSN, FNP-C: So just being mindful can can help with managing our stress. And then. Yeah, as far as DHEA, we kind of talked about that already. As you know, reference ranges are not.

Amber Warren, PA-C: I'm glad you went there. I was definitely going to mention that. Yeah.

Heather Lucas, MSN, FNP-C: A lab might have a reference range for DHEA that maybe it's from. I'm just throwing out a number 150 to 200 or something.

Amber Warren, PA-C: I mostly see like 50 to 200.

Heather Lucas, MSN, FNP-C: 50 to 200.

Amber Warren, PA-C: And we're liking levels of.

Heather Lucas, MSN, FNP-C: We're liking levels in women like 200 to 250.

Amber Warren, PA-C: Yeah, absolutely.

Heather Lucas, MSN, FNP-C: For optimization. And I guess that's the difference if we keep using the word optimization what does that mean. Versus are we just mitigating symptoms or are we optimizing you to really feel your best where we know your body has all the tools it needs to to do to help you feel your best!

Amber Warren, PA-C: Yeah. And it's so much bigger than even feeling your best, right? You already mentioned all the preventative benefit benefits we see, right. With I mean brain, bone and cardiovascular benefits with these hormones. So yes, it's feeling your best the here and now. But what's your life going to look like when you're 60, 65, 70 and you have that family history of cardiovascular disease or Alzheimer's dementia that can be, you know, scary. As we all start to raise children and, you know, feel our aging bodies and we want to be preventing some of these very preventable conditions and diseases as well. Right. So, yeah. Well, I feel like you hit it pretty hard. Other you know, I know you and I both get this question a lot. Non-hormonal treatment options for some of these hormones, right. You mentioned the exercise. The sleep stress management is huge. I can't help but think, you know, women in their late 30s to early to mid 40s. It also happens to be a time that you're in the thick of raising children, the thick of working.

Heather Lucas, MSN, FNP-C: Your career.

Amber Warren, PA-C: Your career. Yeah, trying to take off with multiple things or even just the stress of, you know, I mean, I'll speak for myself, you know, you start to see that your kids there, it goes so fast, you know, and you want to really take advantage of that time. And just the added stressor of, yeah, just raising children, trying to keep your marriage, you know, at an A minus B plus at best. Right. I mean, it's just you're juggling so many things. And so it's so easy to tell us as women like manage your stress, it's like, great, tell me how to do that.

Heather Lucas, MSN, FNP-C: It's stressful hearing that.

Amber Warren, PA-C: It is. It is really stressful hearing that, but I love how you gave the tips of, you know, like deep breathing, going for a walk, doing even if it's 5 to 10 minutes a day of of of self-care. Right. I think for women too, at our stage of life, being okay, saying no. Right. You know, and just really learning who you are and what your priorities are and how you're spending your time and who you're spending your time with. I think there's just a lot.

Heather Lucas, MSN, FNP-C: That's such an important point.

Amber Warren, PA-C: Power that comes out of. Yeah, like, knowing internally who you are and the security of just what you're doing with your life. And, you know, I don't know, I think that can mean a lot of different things to a lot of different people. But.

Heather Lucas, MSN, FNP-C: Right.

Amber Warren, PA-C: It can be really freeing when you kind of learn that and know how to focus your time and your energy and your thoughts.

Heather Lucas, MSN, FNP-C: Absolutely.

Amber Warren, PA-C: Yeah.

Heather Lucas, MSN, FNP-C: Yeah. So if you were asking some more practical. Yes. Not ways to like non non-hormonal ways to support your natural hormone production. Stress management.

Amber Warren, PA-C: Yeah.

Heather Lucas, MSN, FNP-C: A supporting liver detox.

Amber Warren, PA-C: Love it!

Heather Lucas, MSN, FNP-C: So ensuring that you're getting 30 to 50g of fiber in your diet daily. Daily bowel movements so important. Hydration with electrolytes. Not just plain water, but electrolytes so that you're absorbing the water into your cells. And alcohol. Alcohol is not doing you any favors. It's it's harming your gut. It's hurting the bacteria.

Amber Warren, PA-C: It's hard on your liver.

Heather Lucas, MSN, FNP-C: It's hard on your liver.

Amber Warren, PA-C: It's just destroys your sleep.

Heather Lucas, MSN, FNP-C: Yeah. Destroys your sleep.

Amber Warren, PA-C: Yeah. I do feel like alcohol is actually getting, you know, it's it's interesting. Now, we don't eat out a lot, but the couple, you know, I don't know, once a month or once every two months, we do eat out. I notice on all the menus there's now mocktail options. Like it's now cool to have an alcohol free drink. And I love that.

Heather Lucas, MSN, FNP-C: There's there's new social media terms like "sober curious" or.

Amber Warren, PA-C: Are there?

Heather Lucas, MSN, FNP-C: Yes.

Amber Warren, PA-C: Oh, I love it!

Heather Lucas, MSN, FNP-C: So I think the pendulum is starting to swing. People are realizing that alcohol, there's really no health benefit to alcohol.

Amber Warren, PA-C: There really isn't.

Heather Lucas, MSN, FNP-C: It's become socially acceptable and even in some cases, socially expected that people would have a drink if they're out to dinner. But it seems like there's a movement out there. People are kind of starting to value their health a little bit more and thinking, why am I putting this in my body?

Amber Warren, PA-C: Yeah. And we all need to be thinking about it.

Heather Lucas, MSN, FNP-C: It's a great movement. I like it. Uh, balancing blood sugar can help too. That's another non-hormonal way to support your natural hormone production. So focusing on protein, getting a gram of protein for every pound of lean body weight that daily, uh, focusing on healthy fats, avocados, nuts and seeds and fatty fish.

Amber Warren, PA-C: Yep.

Heather Lucas, MSN, FNP-C: And then reducing refined carbohydrates. We don't need added sugar in our diet. And the added sugar just feeds bad bacteria in our gut and and adds to what we call gut dysbiosis, which is an imbalance in good versus helpful bacteria that that live in our gut.

Amber Warren, PA-C: And that concept of just, you know, the gut microbiome and dysbiosis is also really important in your metabolism. So even aside from your hormonal imbalances, I don't think enough people pay attention to gut health when they're trying to lose weight. Right. And evaluating that, that aspect of their body when it comes to a healthy metabolism. So yeah, gut health is so important.

Heather Lucas, MSN, FNP-C: And even thinking about reducing exposure to environmental toxins, we live in such a toxic world from the food, the air, the water. I don't want to sound like a Debbie Downer on this, but, you know, just looking at things to clean up your skincare, go on the apps that are out there, the Environmental Working Group, Ruka, I think is another app. There's so many apps out there that can just help you. You just scan your products and find out. It's rated like a scale of 1 to 10 or green, yellow, red type thing. On what is a clean and healthy product to be putting on your skin, rather than something full of chemicals that your body doesn't recognize. Your liver has to try to process and remove and even nontoxic, like household cleaners and stuff like that.

Amber Warren, PA-C: I was going to say, ladies, this is so much more than just like your shampoo, your lotion and your makeup. This is also.

Heather Lucas, MSN, FNP-C: Things that you use.

Amber Warren, PA-C: The cleaners, the candles.

Heather Lucas, MSN, FNP-C: Fabric softeners, laundry detergent, candles. Yeah. Good point. Air fresheners, perfumes, all of these things.

Amber Warren, PA-C: Yeah.

Heather Lucas, MSN, FNP-C: Our body has to to process.

Amber Warren, PA-C: Yeah.

Heather Lucas, MSN, FNP-C: And then in water, you know, don't drink tap water. Invest in a water filter, helps to filter out heavy metals and.

Amber Warren, PA-C: Environmental toxins and pesticides. Yeah. Our city water here in the Treasure Valley is not. It's not ideal. I'm not sure there's a lot of city waters that are that are actually ideal though.

Heather Lucas, MSN, FNP-C: And then lastly, I would say nutrient deficiencies really working with a functional practitioner or somebody who's going to look at your nutritional status and see, you know, are you a little low on zinc? How's your magnesium? I can guarantee it's low because we all are low in magnesium. And magnesium is so important in stress management. So if stress or anxiety and depression, all these things are part of low hormones and we're not supporting with simple things like magnesium, well, there's some low hanging fruit that we have to to look at and deal with.

Amber Warren, PA-C: And kind of like we were talking back to the DHEA. These are simple blood tests that should not cost an arm and a leg. And every provider should know how to order these. Simple. And if you if you are talking to a provider and trying to get these labs ordered, the red blood cell level RBC is the most accurate one because you can look at like a serum magnesium, but your RBC levels are actually going to be a little more, you know, what's what's in your cell, what's it's going to be a little bit more accurate when you're looking at that. So just a helpful hint if you are trying to work with a practitioner and inquiring about these lab tests to get.

Amber Warren, PA-C: So good, you just gave so many good tidbits that people can apply at home. Okay. Now getting into the nitty gritty, when is it not enough to just use sleep and stress management and a healthy diet to really optimize those levels? Right. We mentioned it with DHEA. We're looking you know, we have our own kind of optimal ranges. We see we kind of think some of the reference ranges out there for hormones are bogus. But when is that not enough and when who is a good I guess I'm also asking who are, who is a good candidate for getting some of these hormone levels optimal? And by that, I guess we're talking about bioidentical hormone replacement, because this is a whole can of worms. We can open on some of the myths behind, you know, bioidentical versus synthetic HRT.

Heather Lucas, MSN, FNP-C: Yeah, yeah. For sure. Well, I feel like you just asked me, like, maybe three questions in there or four questions.

Heather Lucas, MSN, FNP-C: Where do we start?

Amber Warren, PA-C: Break it down however you want, girlfriend!

Heather Lucas, MSN, FNP-C: Well, I you asked about, when is diet and lifestyle changes? Not enough?

Amber Warren, PA-C: Not enough. Let's start there. Yeah, I like that.

Heather Lucas, MSN, FNP-C: So diet and lifestyle can be complementary to hormone replacement therapy. Mhm, but we know that as women hit menopause the ovaries really do stop functioning. And, and there's no amount of diet and lifestyle changes that we can do to bring those back or to replace the hormones that our bodies once were capable of making on their own. So, you know, we can we can focus on exercise, sleep, eating clean protein, healthy fats, decreasing dietary sugar And ensuring healthy levels of micronutrients. But in addition to that, hormone replacement therapy is an option. It's not right for everybody, right? They have to make a decision and educated and well informed decision about it. But bioidentical hormone replacement therapy has been shown in many studies and proven to help to reduce osteoporosis, improve cardiovascular health, and reduce your risk of Alzheimer's dementia. So beyond even just the hot flashes, night sweats, anxiety, depression, there are real health benefits to having optimized hormone levels.

Amber Warren, PA-C: Yeah. And so who might not be a good candidate for bioidentical hormone replacement therapy.

Heather Lucas, MSN, FNP-C: So yes. Hormone replacement therapy does have some risks that come along with it. I would say your your main risk would be working with someone who is not educated in hormone replacement therapy.

Amber Warren, PA-C: That's a great response.

Heather Lucas, MSN, FNP-C: We can really mess people up if we don't know what we're doing. Yeah, and it's not enough. There's there's there's research that shows estrogen replacement therapy is being done out in the conventional medicine world, but always the lowest dose for the shortest amount of time, just enough to decrease hot flashes and night sweats. But we know in the research it shows that if we can get your estrogen level greater than 50 and ideally between 60 and 80 is where we see all the cardiovascular, brain and bone benefits. So it's not enough just to stop the hot flashes and night sweats. We've got to go a little bit further.

Amber Warren, PA-C: We're actually looking for those optimal values.

Heather Lucas, MSN, FNP-C: Exactly.

Amber Warren, PA-C: Yeah. So it's also I mean in that that also makes me think in making sure you're working with someone that knows what they're doing, are they checking your levels before and after and making sure those levels are getting in the optimal range and not too high, right? Because when you have too much unopposed estrogen, that's where you can. And by unopposed, I guess we should kind of define what that means, right? What's unopposed? Estrogen in the body.

Heather Lucas, MSN, FNP-C: Yeah. So estrogen needs to be complemented with progesterone. If estrogen is our hormone of growth, it it's proliferation. It it grows the lining of our, of our uterus and progesterone counteracts that. And it's like the it's like the accelerator and the brake pedal. Yeah. And so if they are out of balance, you're either going to have a whole lot of growth and not enough suppression or so much suppression, not enough growth, so that you're not really achieving the optimal benefits of having the hormone replacement. So it's really a delicate balance between the two. To make sure that, we're doing all good and no harm.

Amber Warren, PA-C: Yes, of course we're treating the the patient in front of us. But we also need to look at what's what are your lab values telling us.

Heather Lucas, MSN, FNP-C: Right. Right. And when you talk about other risks of hormone replacement therapy. So there's many different routes of administration that we can talk about. Specifically oral estrogen I've seen used out in the conventional medicine world. And that is one that carries the most risk with it. It it has to go through our liver and it increases our risk for blood clots and which can lead to deep vein thrombosis or stroke or heart attacks. So oral estrogen is kind of a not not the best route.

Amber Warren, PA-C: And it's pretty controversial because a lot of people will say it gives you the most benefit to your cardiovascular system without some of the risks. And there's some of the literature that doesn't fully support that.

Heather Lucas, MSN, FNP-C: Right. But we do know that transdermal administration pellets or patches provide the benefits of hormone replacement therapy for estrogen and with very low side effects of it. So risk, you know someone if they had a history of a clotting disorder or they have risk of cardiovascular disease, they have a family history, or maybe they've already had a heart attack in their past. They would not be a candidate for estrogen replacement therapy. But that doesn't stop them from being able to receive progesterone. Progesterone is our calming hormone, very helpful in helping with sleep. And it's actually breast cancer preventative.

Amber Warren, PA-C: Yes it is.

Heather Lucas, MSN, FNP-C: We have hormone receptors in every tissue of our body, brain, heart, gut, skin everywhere. And so, you know, I've even heard stories of conventional medicine saying, oh, you don't have a uterus. For a woman who's had a hysterectomy, you don't have a uterus, you don't need progesterone. There couldn't be anything further from the truth than that. In fact, it's breast cancer protective. So yes, even if you don't have a uterus, you want to be on oral micronized progesterone.

Amber Warren, PA-C: Yeah, I would agree. And what's the difference between. Well in this case let's talk about progesterone right. I mean there's there's a lot of different kinds of progesterone you can be putting in our body. Right? Cream versus oral. There's synthetic progestins that are have have no similarity to our bioidentical progesterone. So that's the kind of progesterone that's actually in birth control. And a lot of our young women aren't fully educated. On the risks of these synthetic progestins. It's just not the same as as what our body makes and what our body can respond to.

Heather Lucas, MSN, FNP-C: Yeah. It doesn't have the protective benefits as a true progesterone, which is the same hormone as our body makes. Progestin is a synthetic version of it. And think about it. If with these synthetic hormones is it's kind of like the key fits in the lock. But you can't turn it. So the synthetic progestin fits in the lock in the, in the hormone receptor, but it doesn't turn the key.

Amber Warren, PA-C: Do anything.

Heather Lucas, MSN, FNP-C: It's not doing anything. It's not providing the the hormone benefit in your body.

Amber Warren, PA-C: Yeah. Well, and I think the other important thing to know also is that, yes, you're spot on with the progestins, but also if your body is getting it from a synthetic source, it's not going to be making as much endogenous. So these 25 year old women that are on birth control and have been since they were 15 years old, I mean, goodness gracious, I don't even want to know how they're going to feel when they're 35, 36, 37 years old after 13 years of birth control, after getting the synthetic version, then you really get depleted, and it's so much harder for your body to make these endogenous chemicals. So yeah, I think that's a really important message to get out there.

Heather Lucas, MSN, FNP-C: Yeah, it's so important.

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Amber Warren, PA-C: Wonderful. Yeah. So back to bioidentical hormone replacement therapy and what we're really trying to do here. How do we see HRT impacting mood, libido, just overall well-being, well-being and how we how we just feel and function as women?

Heather Lucas, MSN, FNP-C: Sure. So estrogen, you know, our back to our three main sex hormones again. Estrogen replacement therapy can improve vaginal lubrication, elasticity, blood flow. It helps to support serotonin and dopamine levels, which leads to reducing depression and anxiety. Also helps with memory and focus. It also improves bone density and cardiovascular function, reducing the risk of osteoporosis and cardiovascular disease. Progesterone promotes relaxation and reduces stress related libido suppression. Oral progesterone acts on the Gaba receptors in the brain, which helps to helps with relaxation and deep sleep quality. So oral micronized progesterone, taken about an hour 30 minutes to an hour before bed, helps you to get into that deep sleep where that real that like REM sleep where you're just getting real deep, restorative sleep and can help us stay asleep longer. And then testosterone plays a crucial role in sexual desire. Arousal helps boost motivation, confidence and mental clarity. It's kind of our like, get up and go hormone. Like, I can I can take on this day.

Amber Warren, PA-C: And it helps with sleep, to right the brain, to calming the brain down and helping with that deep sleep.

Heather Lucas, MSN, FNP-C: Very active in the brain.

Amber Warren, PA-C: Very similar to progesterone. Yeah.

Heather Lucas, MSN, FNP-C: And then estrogen and testosterone together they both improve our mitochondrial function. Yes and muscle mass leading to better endurance and strength.

Amber Warren, PA-C: I love it. So back to the mitochondrial function. So that's one that can really help energy. Sure. Right. So your patients coming to you with just low energy in general. Mhm. Hormones.

Heather Lucas, MSN, FNP-C: Yeah. Is it low energy from not getting good sleep or is it low energy from having deficient testosterone.

Amber Warren, PA-C: This is another one to go off the topic of our sex hormones a little into other hormones. Thyroid. Because I feel like there's so many conversations around our hormones and women. Just assume that it's your sex hormones you're talking about. But you know we've talked about cortisol and there's other adiponectin and leptin that are also important for for metabolism. But that appears a little bit too much off topic thyroid. So you and I have talked so much about this poor T4 to T3 conversion that Everybody has. Right? So when we're talking about that, TSH gets produced from the pituitary gland in the brain and it makes sorry it acts on the thyroid gland. To make T4, T4 has to get converted into T3. And I see women come to me with labs and they have not had a T3 or a reverse T3 checked on their thyroid lab panels, or they have also not had thyroid antibodies checked. And I read some statistic the other day that 85 to 90% of hypothyroidism, weight gain, brain fog, cold intolerance, muscle aches and pains, constipation, fatigue is due to this this autoimmune thyroid disease otherwise known as Hashimoto's. Right? So women if you are if you are gaining weight, you are not feeling your best, you're depressed, you're achy all the time. Absolutely. Look at your sex hormones. But make sure someone is also checking thyroid function. Which includes a full panel with thyroid antibodies to see if your body is attacking itself. We need a whole nother podcast on Hashimoto's and hypothyroidism.

Heather Lucas, MSN, FNP-C: Thyroid. Yeah.

Amber Warren, PA-C: But back to the T4 to T3 conversion. And what Heather and I mean is that your T4 levels actually look pretty good. Again, we're looking for optimal ranges here, but your T3 is in the tank and we know there's lots of different things we need to convert adequately. What's the sex hormone We need to convert adequately?

Heather Lucas, MSN, FNP-C: Oh the progesterone.

Amber Warren, PA-C: Progesterone, oh my goodness. We learned this. And it was like this aha moment for Heather and I to say "oh goodness". Yes we know toxins. We know stress can all inhibit that production. But women need progesterone to convert our thyroid hormones appropriately. So a lot of it does come back to that hormone imbalance is truly being root cause, right? I still think there's a lot of this talk of you can fix your hormones naturally. You know, eat well, sleep, and it'll get you optimal. But no, really, truly, we're seeing that these perimenopause, postmenopause hormonal imbalances can truly be the root cause of some of these diseases and conditions that we're seeing. So. Yeah, it's so important. Sorry, I veered a little bit off course, but I've just been so passionate about that. Because progesterone is so important for so many different reasons. Our wellbeing, our thyroid health, sleep. If we could just fix some of these women's sleep, it would just take them so far. Okay, so I digress. Now I'm regressing back onto the topic. Other misconceptions about bioidentical HRT. I know you've touched on a lot of them, but I want to make sure we, we hit them all just to kind of bust, bust some of the myths out there.

Heather Lucas, MSN, FNP-C: Yeah. You know, I mean, it's it's unfortunate, but it goes back to 2002 with the Women's Health Initiative study that came out saying that hormone replacement therapy causes breast cancer and cardiovascular disease. And unfortunately, in that study, they were using synthetic hormones. They were using Prempro, which is synthetic estrogen, synthetic progesterone. And, I mean, the outcome of their study was was not good. But it's also we're also not using those hormones in in our patients.

Amber Warren, PA-C: Right.

Heather Lucas, MSN, FNP-C: And so we're not comparing to apples to apples there. And so unfortunately you know here we are 20, 23 years later, still dealing with the same negative outcomes of that study that was just poorly done. And we're we're doing our best to try to educate and and reverse that, that thought process in people. But it's still seems to be so common in our conventional medicine world. And I'm not trying to throw shade at the conventional medicine world. There's not a lot taught about hormones in med school or NP school.

Amber Warren, PA-C: That's a really good point.

Heather Lucas, MSN, FNP-C: I was reading something. They get about two hours of education on on hormones is as ob-gyns on hormone replacement therapy. And I was reading a statistic that some 75% of residents coming out of med school do not feel comfortable talking about women, talking to women about menopause, or how to deal with that transition in life and what a disservice we're doing to women.

Amber Warren, PA-C: It is, isn't it? Well, so many women will say, well, my doc wouldn't check my levels of hormones. And I'm like, well, yeah, we're not going to check labs if we don't know what to do with them, right? So some of these practitioners that aren't educated, if I wasn't educated on hormones, I wouldn't feel comfortable ordering all of these sex hormones on a client if I didn't know what to do with those labs. Right? And I'm responsible for interpreting those labs and knowing how to apply them to what's going on with your body. So. Yeah. No, you're right. It is such a disservice to women.

Heather Lucas, MSN, FNP-C: So super important that you're working with a provider who has gone the extra step to educate themselves or to to be knowledgeable about hormone replacement, about menopause, that they can so that they're safe in, in replacing your hormones and they're using the right delivery method.

Amber Warren, PA-C: Absolutely.

Heather Lucas, MSN, FNP-C: To, to replace your hormones.

Amber Warren, PA-C: Pellets. Tell us a little bit about pellets for women.

Heather Lucas, MSN, FNP-C: Yeah. Pellets. So we can do estrogen or testosterone pellets. We work with a company called EvexiPel that makes our compounds our pellets with ethyl cellulose combined into them so that there's a delayed release over time. You're not getting a huge spike and then a big drop off in your hormone levels. It's a it's kind of a gradual three three week climb up more of a plateau out and then a gradual decline off where you would come in and get another, another pellet placed. And for women, it's about every 3 to 4 months that you would get your hormone pellets replaced. It's a really nice and convenient delivery option. You're not having to think about giving yourself an injection, or applying a patch or applying cream every day. It's, you know, it's it's a minor, minor procedure. Takes about 15 minutes in the office and it's every 3 to 4 months. So I love pellets as my it's my favorite hormone delivery method.

Amber Warren, PA-C: Yeah. Wonderful. Yeah. So pelleting estradiol and testosterone. You still want to take the oral progesterone in most cases.

Heather Lucas, MSN, FNP-C: Yes.

Amber Warren, PA-C: For the endometrial protective benefits and just those brain protective benefits we get from progesterone.

Heather Lucas, MSN, FNP-C: Yeah. And then some of the other misconceptions about HRT that need to be addressed is, you know, HRT is only for severe menopausal symptoms.

Amber Warren, PA-C: Agreed.

Heather Lucas, MSN, FNP-C: Well, why why does it have to be only for severe stuff? Like why? Why can't we, you know, why can't we all just fill our best if there's very little low risk and nothing but benefits to gain from it? Why wouldn't we replace our hormones if we're the right candidate for it? Another misconception is that HRT is dangerous for the heart or causes weight gain. Estrogen actually helps to maintain healthy metabolism and is protective on the cardiovascular system. Only women in their 50s can use HRT. Well, no, we can actually start with progesterone and testosterone replacement in our late 30s, early 40s.

Amber Warren, PA-C: How would you advise a woman that's maybe 65, 70? New diagnosis of osteoporosis? You know, reading about the benefits of HRT. How would you advise a woman who's, you know, ten years post menopause and considering the use of hormones for or for, you know, concerning signs of dementia or cognitive decline?

Heather Lucas, MSN, FNP-C: Sure. Well, there is no recommended age to start or stop hormone replacement therapy. Let's just get that out there. It doesn't matter if you're premenopausal or ten years post menopausal. You can start hormone replacement therapy at any point in time and you will still receive benefits from it. So someone looking at maybe they've gone for a Dexa bone scan and they've been told they're osteopenic, or maybe they've advanced far enough to the point to where they're actually osteoporotic. Testosterone and estrogen could be great.

Amber Warren, PA-C: Beneficial for the.

Heather Lucas, MSN, FNP-C: Moments to help with with that with helping the bone restructuring, also ensuring that you're getting plenty of collagen in your diet and vitamin D with K2, other micronutrients.

Amber Warren, PA-C: Exercising that muscle resistance exercise.

Heather Lucas, MSN, FNP-C: Exactly.

Amber Warren, PA-C: Yeah, so many different things we can do.

Heather Lucas, MSN, FNP-C: So many different things that we can do rather than using another pharmaceutical.

Amber Warren, PA-C: I love it. So what advice would you give to women that are just concerned and, you know, concerned about, I guess, just replacing their hormones because they want to try and do it naturally. What's your advice to a woman who says, I just really want to go through this change naturally?

Heather Lucas, MSN, FNP-C: My advice would be to educate yourself, to work with someone who can provide quality education for you. Peer reviewed studies, not just social media posts. Or, you know, I heard my friend kind of had this experience, so I don't ever want to do it. Don't don't go down that road, ladies. Like, really work with someone who knows what they're what they're doing. And we spend 40% of our lives post-menopausal. That's a big portion of our lives to not feel our best or to be playing with fire a little bit, if you will, like our risk of cardiovascular disease and Alzheimer's, dementia goes up if we don't have our hormones optimized. So I mean, it's not going to be right for everybody, but at least make an educated decision for yourself.

Amber Warren, PA-C: Yeah. Go see someone. I love that advice. Go see someone who knows what they're doing and who's educated in it.

Heather Lucas, MSN, FNP-C: And don't suffer in silence.

Amber Warren, PA-C: Yeah.

Heather Lucas, MSN, FNP-C: Talk to your provider about the symptoms that you're experiencing. Not every woman will have the exact same symptoms of of perimenopause or menopause. Some women may have bone and joint aches and pains. Some women might have more of the hot flashes and night sweats. Everybody's a little different.

Amber Warren, PA-C: Other women might just be gaining weight.

Heather Lucas, MSN, FNP-C: Exactly.

Amber Warren, PA-C: Or might just be really irritable.

Heather Lucas, MSN, FNP-C: They're just grumpy by nature.

Amber Warren, PA-C: So stop letting your stop just allowing your husband to give you a hard time. Get those hormones checked, right?

Heather Lucas, MSN, FNP-C: That's right.

Amber Warren, PA-C: Because it might just not be your fault. It's your dang hormones.

Heather Lucas, MSN, FNP-C: Yeah, and you might open up a whole new a whole new chapter to your life that you are so excited to be in.

Amber Warren, PA-C: Yeah, that's so true. Yeah. Ladies, we hope you can share this, this, this episode and just these tidbits of information with friends and families and mothers and sisters and daughters because yeah, I agree, no one should have to suffer in silence. And we can't over overemphasize the importance of yes, feeling your best and, you know, bringing your best home to to your spouse and your family and your children, right? And being able to show up for your loved ones, but also the preventative benefits we see because we are not very healthy country and we'd love to be able to see statistically some of these, you know, like even just cardiovascular disease, some of those statistics improve. So yeah, it'd be wonderful. Wonderful to see. Thank you. You are such a wealth of knowledge and we are so blessed and honored to have you here. Heather is accepting new patients and she is rocking and rolling doing all things, uh, pellets and hormone optimization and thyroid health. And so, yeah, if you're interested in learning more about Heather, please go to our website and check out her bio. Thank you for joining us.

Heather Lucas, MSN, FNP-C: Thank you.

Amber Warren, PA-C: Thank you for listening to the Functional Medicine Foundations podcast. For more information on topics covered today. Specialties available at the FMI Center for Optimal Health and the highest quality of supplements and more go to funmedfoundations.com.